Bulimia nervosa is a complex eating disorder that arises from a multitude of emotional and mental health issues. Impactful treatment approaches seek to resolve these issues in addition to helping an individual break the binge and purge cycle. Treatment seeks to create a link between an individual’s thought patterns and their relationship with food.  

As with all disorders, an individual cannot obtain treatment if they do not realize that they have a problem in the first place. The prospect of addressing an eating disorder often instigates intense fear because individuals become can become terrified to lose control. Due to the severity of the disorder, individuals need to understand the importance of professional treatment and medical intervention. Once convinced, individuals need to closely adhere to a treatment regimen, so they can learn to manage the disorder.       

A cohesive clinical team is necessary for treatment to be effective. Individuals may choose to receive treatment at an eating disorder facility, containing medical physicians, mental health professionals and nutritionists on staff. Alternatively, people may wish to see their providers separately, while connecting them for collaboration purposes.  

Initial treatment begins with a physical exam and a variety of laboratory tests to address physical or medical issues that may have been caused by the disorder. The beginning stages of treatment may include a visit to a nutritionist to help educate the person about healthy nutrition and consumption patterns. Finally, an individual may be referred to a psychiatrist and psychotherapist for psychotropic medication, medication monitoring and weekly psychotherapy intervention.   

Medications Used for Treating Bulimia

Medication cannot cure bulimia by itself and should never be the primary form of treatment. However, medication can be helpful when used in conjunction with other types of psychotherapeutic treatment. Some medications have been found to decrease the occurrence of binge and purging episodes in addition to being effective in treating co-occurring mental health problems.

Antidepressants are the main pharmacological treatment for bulimia, these types of medication have gentle side effect profiles and have been proven to be helpful in diminishing anxiety and preoccupation with body shape and weight. Currently, Fluoxetine (Prozac) is the only psychotropic medication that is approved by the Food and Drug Administration (FDA) as a treatment for bulimia. Prozac can assist individuals in reducing binging and purging behaviors while helping to elevate moods in those people with comorbid mental health disorders.

SSRIs

Selective serotonin reuptake inhibitors, commonly referred to as SSRIs, target the neurotransmitter serotonin, which controls feelings, disposition and appetite. SSRIs seek to increase serotonin levels in the brain’s synapses. SSRIs do not address weight loss directly but are utilized to treat depression and anxiety in people who struggle with bulimia.  

Therapy for Bulimia Nervosa

There is a multitude of psychotherapeutic treatment options for bulimia that may include types of individual, group or family therapy. Cognitive-behavioral therapies are often indicated, as behavior therapy targets binging and purging habits and ways to change them, while cognitive therapy aims to explore and alter negative thought patterns that drive detrimental behaviors. Individual and group therapy can assist individuals in exploring and processing emotions and relationships that play a role in bulimia. Other alternative therapies do not target underlying causes of bulimia but serve to reduce physical suffering by strengthening mental control.

Cognitive-Behavioral Therapy

Cognitive behavior therapy (CBT) is used to treat bulimia by addressing both the behaviors and negative cognitions driving these behaviors. This form of treatment focuses more on the present and less on the past and how symptoms progressed. CBT educates patients about the detrimental impact of binging and purging, diminishes body image and weight issues, and assists in developing healthy eating and weight monitoring behaviors. CBT seeks to disturb the elements that perpetuate the binge and purge cycle so that individuals can learn to restrain themselves.

Family Therapy

Family therapy seeks to address the family system and focuses on how the disorder has impacted the overall unit. Someone with bulimia will be prompted to see the dysfunction in the scope of the family system and can develop an understanding of how their disorder propels dysfunction. Families will be educated about the importance of regular eating schedules, identifying problematic behaviors and learning how to respond to these behaviors when they occur. Family therapy assists family members to create hope and feel encouraged to help their loved ones.  

Psychotherapy

Psychotherapy is the most customary treatment option for bulimia and directs attention to unhealthy eating patterns and an individual’s overall emotional welfare. The main focal point of psychotherapy is to heal from feelings and thoughts that led to the eating disorder in the first place.    

Alternative Treatment Options for Bulimia   

A variety of alternative interventions exist in treating bulimia. Body awareness therapy concentrates on movements and mindfulness. Yoga can help individuals reduce stress and improve body image, while acupuncture seeks to improve general health. Massage therapy increases levels of serotonin, which has a positive impact on mood.

Treatment for Bulimia and Co-Occurring Disorders

Individuals with eating disorders frequently struggle with both mental illness and addiction, making complete and thorough treatment essential. Early interference and the use of proper treatment protocol can greatly improve effective outcomes. Co-occurring undiagnosed substance use disorders can have a significant impact on an individual’s overall well-being.

Integrated treatment options serve to address eating disorders and addiction concurrently. Treatment is successful because it enables individuals to process and understand dormant issues that play a role in both conditions. Integrated treatment involves collaboration from a clinical team including physicians, nutritionists, psychiatrists and mental health professionals.

Depending on the severity of the co-occurring disorders, treatment can be provided in various settings, ranging from lower outpatient levels of care to higher levels of care in hospital settings. Detoxification can potentially be necessary depending on the acuteness of the addiction. Due to the complex nature of co-occurring disorders, it is imperative that individuals obtain individualized care tailored to their specific conditions.     

Bulimia and Anxiety

It is believed that anxiety precipitates the onset of an eating disorder because worry can quickly evolve into a search for control. Anxiety is an extremely common co-occurring condition to bulimia. Obsessive-compulsive disorder (OCD), social anxiety disorder and post-traumatic stress disorder are all linked to the onset of eating disorders. The most common is OCD because both disorders share compulsive ritual habits. Since anxiety and bulimia are interrelated, they must be treated simultaneously, while ensuring targeted help toward both conditions.  

Bulimia and Depression

Depressive symptoms often accompany bulimia.  However, it is unclear if depression develops simultaneously with an eating disorder or if it precedes it. Treatment of depression and bulimia is most effective with psychotherapy and psychotropic medication. Antidepressant medications and mood stabilizers seek to alleviate depression and elevate depressed mood.

Bulimia and Substance Abuse

Bulimia is an extremely dangerous disorder by itself, but when paired with a drug or alcohol addiction, it can become more serious. These issues share the commonality of an addictive personality and can have both physical and mental side effects.

Someone with an eating disorder may utilize substances to self-medicate, suppress their appetite or may perceive substances as being less dangerous than they are. Since eating disorders and addiction are often intertwined, co-occurring disorder therapy must address both conditions simultaneously.”

Support Groups for Bulimia

Support groups are extremely common for conditions such as alcoholism, drug use or gambling and seek to support people so that they have a better chance of staying away from their addictions.

Eating disorders are more complicated because individuals cannot simply stay away or eliminate eating. Thus, an eating disorder support group can support members with developing a healthy relationship with food. Members share experiences and can relate to commonalities of what other members are encountering. Support groups can be held in person or via online forums.

Fortunately, there is a multitude of treatment options for bulimia nervosa and its commonly co-occurring disorders. Bulimia is complex, and the development and progression of the disorder manifest differently in each client.  Treatment should be individually tailored to achieve and effective treatment outcome.

Bulimia Treatment
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